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Not so new member having mask leak issues
#1
Not so new member having mask leak issues
My doctor upgraded my Resmed S7 Vpap machine to an AirCurve 10 ASVAuto machine about 3 months ago. Since I received my new machine I awaken every night by leaks. Vibration and sound.
I thought it was improper mask sizing due to significant weight loss. So off to the sleep center and each time I was prescribed a different mask or nasal pillow.
FF Mirage Quattro
FF AirFit F10
FF Philips Respironics
Mirage Liberty FF w/ nasal pillow
Nuance & Nuance Pro Nasal Pillow

Nothing has worked. And the sleep center said that they are out of options for me.
So here I am at the Apnea Board trying to navigate my way to a good night’s sleep.

I am thinking that it isn’t the mask fit at all and perhaps the settings on my machine are incorrect and if I could simply lower the pressure, then leaks would be eliminated.
The problem is that I am having a really tough time understanding how and what should be adjusted on the AirCurve.
Could someone help me determine if the settings on my machine appear to be high?

Machine Settings
Mode CPAP ModeASVAuto
Min EPAP 5.00 cmH2O
Max EPAP 15.00 cmH2O
Min IPAP 9.00 cmH2O
Max IPAP 30.00 cmH2O
PS Min 4.00 cmH2O
PS Max 15.00 cmH2O
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#2
While reducing pressure can reduce leaks, it can also compromise your therapy. Some suppliers (#1 from memory, see list at top of page) will allow you to return them. I have been using a F&P Simplus with mostly good results. A lot of people here have reported good results with the Simplus. I have recently been trying a Mirage Quattro but I just can't get it to seal well.

Your max pressure is pretty high. 30, that is impressive! Have you had a new titration since your weight loss (congrats, that is a hard thing to do)? You will probably find that you need to really snug down the mask to get a decent seal. Even at 15 I need to get the Simplus on the tight side. Then again, perhaps I am doing it wrong too! Big Grin

I am not sure why the change in machine would cause this. Perhaps your old one was getting out of spec?
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#3
(11-24-2016, 12:29 AM)chill Wrote: While reducing pressure can reduce leaks, it can also compromise your therapy. Some suppliers (#1 from memory, see list at top of page) will allow you to return them. I have been using a F&P Simplus with mostly good results. A lot of people here have reported good results with the Simplus. I have recently been trying a Mirage Quattro but I just can't get it to seal well.

Your max pressure is pretty high. 30, that is impressive! Have you had a new titration since your weight loss (congrats, that is a hard thing to do)? You will probably find that you need to really snug down the mask to get a decent seal. Even at 15 I need to get the Simplus on the tight side. Then again, perhaps I am doing it wrong too! Big Grin

I am not sure why the change in machine would cause this. Perhaps your old one was getting out of spec?


Yes, I did have a new overnight sleep study prior to getting new machine... terrible night. Felt like a blow fish.
From what I have learned on this forum, the mask should not be cinched down to tight. That the air pressure should pillow the mask and seal against the skin.
Regardless, I have really tried different adjustments with each mask. I really believe that this is pressure setting. But I don’t want to arbitrarily start changing the settings without some guidance.

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#4
Use the software and find what your leak rate is; and how high your pressure actually goes. I'll wager you seldom, if ever, hit 30 cm-water. Your machine is an ASV and has a wide latitude in pressure to make sure you inhale on a breath by breath basis.

I make the Mirage Quattro work at 18. They say it's supposed to float on your face -- well at higher pressures it still floats; but it has to be tight.
Work with the mask. If you're adjusting it when there is zero pressure, it will be too loose.

My opinion is leave the pressure where it's at.
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#5
I agree with Mongo. Your max IPAP is set to 30 because your max EPAP and max PS are both 15 and the machine needs the headroom in case both of those go to max at the same time. I would leave the settings where they are and get Sleepyhead software so you can more easily see where your pressure actually is during the night. Hopefully some of the members with ASV experience will chime in.

The other thing that I would do is to work with your Mirage Quattro some more to reduce the leaks. Check out Taming The Mirage Quattro on the Mask Arrayed blog. It takes a while and some effort to get everything working right with the Mirage Quattro but it does hold higher pressure well. My pressure when I got the MQ was 20 cm/H2O. Another thing to be careful of is the advice that the mask should float softly on your face. This works well at lower pressures but at higher pressure not so much. As Mongo said it still floats but there must be a fair amount of tension in the headgear which will make the mask feel tight. There are some more details that I found helpful to reduce leaks with the Mirage Quattro. I would be happy to share them if you are interested in going back and giving the Mirage Quattro another try.

You will get this fixed. Keep working the problem but do so systematically and do not rush changes. It often takes your body and the rest of the system time to adjust after changes are made

Best Regards,

PaytonA
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#6
(11-24-2016, 12:42 AM)erikk Wrote: From what I have learned on this forum, the mask should not be cinched down to tight. That the air pressure should pillow the mask and seal against the skin.

Yeah, that's the normal advice given here, but for me it doesn't really work. I've tried doing it the recommended way at least ten times and it's always sent my leaks through the roof. I have to tighten it down a fair amount. Fortunately I can get to sleep with it that way.

I use a Simplus FFM.
Ed Seedhouse
VA7SDH

Your brain is not the boss.

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#7
Payton, I've been trying the Mirage Quattro too recently and been having a very hard time getting the leak level down to where I can go to sleep. Thanks for the pointer to Taming The Mirage Quattro, I will check that out. If you have any other hints or suggestions, I'd be grateful for them.
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#8
Here is another place for some advice on fixing leaks on full face masks. Click on Mask Fit to follow the link.

Here is one that I put together a while back. I will post changes and additions a little later.

My Take On Taming The Mirage Quattro

Fear of suffocation

For those new to the full face Mask (FFM). I would like to say a few words about what happens if your CPAP goes off in the middle of the night. The Mirage Quattro like all full face masks has a safety valve that opens to the atmosphere when there is no air coming from the CPAP. It is in the elbow. In addition the vents are open all of the time so there is no danger of suffocation if the power goes out. It may feel a little difficult to breathe immediately if you shut your machine off with your mask still on. This is only because it has been so easy to breathe with the pressure boost the machine gives.

Preparation

If your CPAP has a mask fitting feature you can use that. If not, set the ramp to 0 and disable the bi-level if you are able. If you can not disable the bi-level then only make adjustments during the inhale phase. With my Resmed S8 Auto, I just change to uni-level mode and turn off the ramp. This gives me all of the time that I need to make adjustments. I do this during the day so that there is no time pressure to get to bed. Adjust the mask forehead pads so the adjustment is all the way out – 24. Attach the hose to your CPAP,

Donning the Mask

Attach the top straps of the head gear to the mask. Flip the headgear over the front of the mask. While seated tilt the mask slightly towards your nose and put on the bridge of your nose. Pivot the chin portion of the mask onto your face so that the bottom of the mask rests in the crease between your lower lip and your chin. Holding the mask in the proper position on your face with one hand, use the other hand to flip the headgear over your head and pull it down over the top of your head until you have the lower straps close enough that they can be fastened to the mask. Fasten the lower straps to the mask. Loosen the hook and loop on the lower straps and adjust both at the same time and the same amount until the mask is snug at the bottom but not tight. Repeat for the top straps. With both hands pull the straps away from the head and move side to side to ensure that they and the mask are centered. Do the bottom straps and then the top straps.

Fitting The Mask

Connect tube from CPAP. Start CPAP with settings as described in “Preparation”. There will probably be a lot of leakage. Do not let it bother you. You will make it go away. Loosen the hook and loop on the bottom straps again and adjust both straps together until the leaks at the chin just go away. Fasten the bottom straps. Use the knob on the forehead pad assembly to adjust the nose bridge portion of the mask in (turn knob clockwise) until the leakage just stops.

Lie down on your back in a normal sleeping position adjust bottom straps and forehead knob as necessary to eliminate any leakage. Lay on one side and then the other to check for leaks and adjust as necessary. You should be good to go. Turn off machine. Take off mask.

Here comes the good part! Check the two lower straps and make sure that the hook and loop is the same distance from the end of the loop around the fastener. If they are not, adjust the shorter one to be the same length as the longer one. Repeat for the top straps. The reason for this is to maintain even tension on both sides otherwise leaks can develop more easily.

When you put the mask on to go to bed, get the mask on with the head straps all fastened and then grasp the lower strap behind your head, pull it slightly away from your head and move it side to side slightly to center the headgear and the mask. Do the same for the top strap. Fastening one side at a time puts a little more tension on one side than the other and gets the mask slightly off center. The aforementioned procedure equalizes the tension on both sides and centers the mask and headgear to reduce the tendency to leak.

One last thing, move the headgear up so that the bottom straps are as close under the ears as possible. If you can stand it, it would not be a bad idea to run the bottom strap across the ears. The further up on the skull and away from the neck the bottom straps are, the less effect the tilt of the head has on the strap tension. If your bottom straps are well down your neck from your ear, the strap tension will increase as your head tilts back and decrease as it tilts forward. Of course if it decreases enough the mask will leak.

Happy PAPping,

PaytonA

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#9
(11-24-2016, 08:24 AM)justMongo Wrote: Use the software and find what your leak rate is; and how high your pressure actually goes. I'll wager you seldom, if ever, hit 30 cm-water. Your machine is an ASV and has a wide latitude in pressure to make sure you inhale on a breath by breath basis.

I make the Mirage Quattro work at 18. They say it's supposed to float on your face -- well at higher pressures it still floats; but it has to be tight.
Work with the mask. If you're adjusting it when there is zero pressure, it will be too loose.

My opinion is leave the pressure where it's at.

I will have to find my Mirage Quattro and give it another try.
I do have the SleepyHead software and am still learning to interpret the given data.
here is my sleep report. any comments?
   


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#10
(11-24-2016, 01:24 PM)PaytonA Wrote: I agree with Mongo. Your max IPAP is set to 30 because your max EPAP and max PS are both 15 and the machine needs the headroom in case both of those go to max at the same time. I would leave the settings where they are and get Sleepyhead software so you can more easily see where your pressure actually is during the night. Hopefully some of the members with ASV experience will chime in.

The other thing that I would do is to work with your Mirage Quattro some more to reduce the leaks. Check out Taming The Mirage Quattro on the Mask Arrayed blog. It takes a while and some effort to get everything working right with the Mirage Quattro but it does hold higher pressure well. My pressure when I got the MQ was 20 cm/H2O. Another thing to be careful of is the advice that the mask should float softly on your face. This works well at lower pressures but at higher pressure not so much. As Mongo said it still floats but there must be a fair amount of tension in the headgear which will make the mask feel tight. There are some more details that I found helpful to reduce leaks with the Mirage Quattro. I would be happy to share them if you are interested in going back and giving the Mirage Quattro another try.

You will get this fixed. Keep working the problem but do so systematically and do not rush changes. It often takes your body and the rest of the system time to adjust after changes are made

Best Regards,

PaytonA

Thanks PaytonA
I will read Taming The Mirage Quattro.
Can't believe the support coming from this forum.
Thanks to ALL!
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